title: Heart failure in very old adults.
abstract: Heart failure (HF) increases significantly in relation to advancing age, yet management for HF in very old adults remains ambiguous. With aging, not only do age-related, morphological and physiological cardiovascular changes predispose to HF, there is also increased prevalence of comorbid conditions that compound cardiac limitations (e.g., renal insufficiency and chronic obstructive lung disease) and others that tend to overwhelm limited cardiovascular reserves (e.g., infections and ischemia). Standard HF pharmacological and device therapies do little to moderate the wide spectrum of insidious age-related processes that are elemental to HF pathophysiology among older patients. Moreover, the utility of standard HF therapy is usually premised on its efficacy for life prolongation, whereas quality of life, increased physical and cognitive function, and preserved independence may be regarded as higher (or even highest) priority. In this review we study age-related susceptibility to HF, as well as the utility and limitations of standard HF strategies. Both HF with reduced ejection fraction and HF with preserved ejection fraction are considered.
authors.affiliation: Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA, deforman@partners.org.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Forman
authors.forename: Ali
authors.initials: A
authors.lastname: Ahmed
authors.forename: Jerome L
authors.initials: JL
authors.lastname: Fleg
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000375:Aging / Q000502:physiology*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D058406:Cardiac Resynchronization Therapy; D002908:Chronic Disease; D015897:Comorbidity; D004232:Diuretics / Q000627:therapeutic use; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D010166:Palliative Care / Q000379:methods; D012307:Risk Factors
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics